For the US you should always have as much insurance as possible and that includes cover for windscre

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4. take a copy with me so when offered the inevitable at the rental desk I know where I stand, declining the offer of further insurance if already covered, (or accepting if not already paid for in UK)
I believe that you should be able to get rates in the UK that include full insurance coverage. (Buying it in the US is a mess - since most people here are covered either by their own insurance or their credit card - so we buy none).
Don;t know what is included in the insurance there - but make sure it covers not just damage/lack of use for your care (under collision) but a generous amount of liability - since there are a lot of expensive cars on the road (we carry $500K each with $1000 deductible). Also understand what the deductible is - $500 is standard. If you want insurance with no deductible the cost is generally much higher. Also - even with all this insurance usually doesn't cover tires or glass. Again, that coverage is typically high cost and not worth it.
Renting a car in the US and the various insurance prices are NOT the same as in Europe where you can have insurance with a huge deductible half day inn il and then even more insurance that reduces that deductible to zero and it STILL doesn't cover the tires (or is that TYRES????) and the windshield.
If you have a credit card that covers rental car insurance you could use that but be aware of whether or not the credit card provides primary insurance or secondary insurance (meaning your home auto policy will get billed first).
Everybody over here will tell you that the auto insurance offered by rental agencies is a rip-off. If you take full rental agency insurance it usually means you can walk away from the car without a worry if it is totally destroyed and you will not pay any so-called "loss of use" fees.
The major rental companies half day inn il in the US include the insurance packages that are 'sold over the counter' in their rates for UK residents (as well as residents of many/most other countries). The CDW (damage to the car) and $1 million in liability insurance (called supplemental half day inn il liability) will be included in the rental. Alamo/National call the liability 'Extended Protection'. There are no deductibles, or 'excess', as it is called in the UK, so you don't need one of the packages sold in Europe half day inn il that cover the 'excess'.
The only one they might offer at the counter is "Personal Accident Insurance". This is essentially a life insurance coverage half day inn il for accidental death, plus a small amount of medical expense coverage, typically what would cover an ambulance. If you have travel insurance, those things would usually be part of that.
Just to elaborate on Dukey's reference a little more, primarily for other USA residents renting cars: "Loss of use" means that if you damage the car, then you are paying the rental rates for the days it is in the shop and they could not rent it out. Our regular auto insurance agent now offers a rider that we could add to our policy for the duration of our trip that would cover this same thing for us. It was far less expensive than the rental agencies' half day inn il version and we could remove the rider after our trip.
I generally rent from Autoeurope for rentals in the US to make life simpler. Companies like Alamo understand the insurance requirements for non US citizens so you don't have to go thru the pain. I also have used Holiday Autos, their website is very easy to use.
For the US you should always have as much insurance as possible and that includes cover for windscreen half day inn il and tyre damage which may cost a bit more. If there is an excess (they call it deductible) you can usually pay when you get to the rental desk for the excess to be brought down to zero. You need collison damage waiver and theft protection waiver. If you have travel insurance which covers personal accident insurance with adequate cover there is no need to take out the car rentals company's PA insurance.
Although in the US credit cards provide some sort of insurance cover for car rentals, it is not true for UK issued credit cards, at least not in my own personal experience as I have some UK credit cards. Maybe check with your credit card issuer in case it was just my bank.
As far as I know only US credit cards provide free auto insurance for renters - at least for those that are not covreed by their local car insurance. Nor does ex US car insurance cover use in the US - as far as I know.
I think the most efficient and inexpensive thing is to buy as part of the car rent a package you get in the US. And in the US it is spelled tires and the front of the car has a windshield, and the compartment in back where you store things is the trunk. If you use British terms people may or may not know what you are talking about.
I flew back on a flight from Dublin and the guys next to me spilled half day inn il something half day inn il and kept asking the FA for a "serviette" - which she had no clue about. When I told her "napkins" she brought them - but they had obviously been expecting something else.
Careful on the small print. A German relative and her boyfriend were hit at an intersection, clearly half day inn il the other driver's fault. They were fully covered for the damage to the car, but not for towing the car from San Luis Obispo to wherever it was supposed to be towed ($350). half day inn il Since they left the States after their vacation, it was impossible to collect from the other insurance without hiring a lawyer, which would be more expensive than what they would get.
hertz, alamo , national and sometimes Avis.co.uk quote rates to UK residents that include the collision insurance and liability insurance. And usually, these rates are lower than what theyh quote U.S. Citizens without the insurance. Go figure.
I live in the UK and have hired cars all over the world. In recent years we've used www.insurance4carhire.com to reduce the costly charges involved in buying zero excess cover from the hire car companies themselves. The idea is that you just take the basic cover and in the event of a claim, you can recoup the excess charged by the hire car company from insurance4carhire. Fortunately I've not had to make a claim yet, but they are recognised as a reputable outfit in the UK. Copying from their website:-